The rapid spread of SARS-CoV-2 in 2019 and 2020 has resulted in a worldwide pandemic. [1] [2] [3] [4] The dramatic proinflammatory effects of COV-SARS-CoV-2 results in a wide variety of clinical presentations, however severe pulmonary inflammation, effusions, and rapid respiratory compromise are a hallmark of this disease.[5-7]Subsequent pneumonia, acute respiratory distress syndrome and death have been reported not infrequently. The result of this pandemic is a large and increasing number of

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... tients requiring endotracheal intubation and prolonged ventilator support. [8] [9] [10] [11] [12] [13] Certainly, the rapid rise in endotracheal intubations coupled with prolonged ventilation requirements will lead to an increase in tracheostomy procedures in the coming weeks and months. [14, 15] While generally a well-tolerated and safe procedure, the risks and benefits of tracheostomy in terms of outcomes, pulmonary care, and risks to the health care team remain unknown [16, 17] . Fortunately, while not perfect, rapid testing protocols have allowed us the ability to detect active infection in patients who are affected by SARS-CoV-2. [18] [19] [20] [21] What is clear is that the upper aerodigestive tract, the nasopharynx and the trachea harbor a high viral load during the acute stages of the infection. [22] [23] [24] Therefore, performing tracheostomy in the setting of active COV-SARS-CoV-2 when necessary, poses a unique situation, with unique risks and benefits for both the patient and the health care providers. The risk of this procedure has to be balanced with the known risks of prolonged intubation, primarily tracheal and subglottic stenosis the management of which can be problematic if significant mucosal injury and subsequent stenosis occurs.